Dataset Information

Use of Long-term Cumulative Blood Pressure in Cardiovascular Risk Prediction Models.

ABSTRACT:

Importance

Long-term cumulative systolic blood pressure (SBP) is significantly associated with increased rates of atherosclerotic cardiovascular disease (ASCVD) development independent of single SBP levels. However, published ASCVD risk prediction algorithms only include currently measured SBP.

Objective

To determine whether including long-term (5- and 10-year) cumulative SBP in risk equations improves the predictive ability compared with single SBP measurements.

Design, setting, and participants

Adults aged 45 to 65 years at the time of risk estimation with at least 20 years of follow-up (5 and 10 years prior to risk estimation and 10 years of event follow-up). The Lifetime Risk Pooling Project included data from the following cohorts: Coronary Artery Risk Development in Young Adults Study, Atherosclerosis Risk in Communities Study, and Framingham Heart Study (both the original and offspring).

Exposures

Ten-year ASCVD risk, calculated using the approach of the 2013 American College of Cardiology/American Heart Association 10-year ASCVD risk equations, first with current SBP and then substituting 5- and 10-year cumulative SBP levels.

Main outcomes and measures

Incident ASCVD events that occurred over 10 years of follow-up, compared with the predicted risks, using the C statistic, net reclassification index at event rate, and the integrated discrimination index.

Results

This study included 11?767 participants with a mean (SD) age of 59.1 (4.7) years at risk estimation. A total of 6873 participants (58%) were women, and 1499 (13%) were African American. In the 10 years of follow-up from risk estimation, 1887 participants (16%) had an ASCVD event. There were no significant improvements in the C statistic when including 5- or 10-year cumulative SBP. However, the addition of cumulative SBP resulted in significant improvements in the net reclassification index at event rate (10-year net reclassification index for men, 0.04 [95% CI, 0.02-0.06]; 10-year net reclassification index for women, 0.03 [95% CI, 0.01-0.06]) and the relative integrated discrimination index (10-year relative integrated discrimination index for men, 0.12; 10-year relative integrated discrimination index for women, 0.10).

Conclusions and relevance

Using long-term measures of cumulative blood pressure, instead of single measurements, can modestly improve the ability of cardiovascular disease risk prediction models to correctly classify individuals in terms of their risk for cardiovascular disease.

SUBMITTER: Pool LR

PROVIDER: S-EPMC6583053 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Use of Long-term Cumulative Blood Pressure in Cardiovascular Risk Prediction Models.

Pool Lindsay R LR Ning Hongyan H Wilkins John J Lloyd-Jones Donald M DM Allen Norrina B NB

JAMA cardiology 20181101 11

<h4>Importance</h4>Long-term cumulative systolic blood pressure (SBP) is significantly associated with increased rates of atherosclerotic cardiovascular disease (ASCVD) development independent of single SBP levels. However, published ASCVD risk prediction algorithms only include currently measured SBP.<h4>Objective</h4>To determine whether including long-term (5- and 10-year) cumulative SBP in risk equations improves the predictive ability compared with single SBP measurements.<h4>Design, settin ...[more]

PMID: 30193291

Similar Datasets

Project description:BackgroundCumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.MethodsData from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.ResultsOf the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.ConclusionCumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.

Project description:Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear. Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006-2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006-2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence. Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: <120/<80, 120-129/<80, 130-139/80-89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6-3.2 and 0.2-3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up. Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP.

Dataset Information

Use of Long-term Cumulative Blood Pressure in Cardiovascular Risk Prediction Models.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusions and relevance

Publications

Use of Long-term Cumulative Blood Pressure in Cardiovascular Risk Prediction Models.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets